Mobilization immediately after elective abdominal surgery : respiratory effects and patients´ and healthcare professionals´ experiences

To prevent postoperative complications after abdominal surgery, mobilization is highly recommended and suggested to start as soon as possible. However, few studies have investigated the respiratory effects of immediate postoperative mobilization among patients undergoing elective open or robot-assisted laparoscopic abdominal surgery. Nor have patients´ and healthcare professionals´ experiences of such an early mobilization procedure been investigated. Participants in study I to III were recruited from an out-patient pre-anesthesia clinic at Karolinska University Hospital Solna, Stockholm. For paper IV, the participants were recruited from the postoperative recovery unit at the same hospital. Paper I was a 3-armed RCT, consecutively including 214 patients who underwent elective open or robot-assistedlaparoscopic gynecological, urological, or endocrinological abdominal surgery with ananesthetic duration of >2 hours. Patients were randomized to mobilization only (to sit in a chair) (n = 76), mobilization (to sit in a chair) in combination with breathing exercises (n = 73), or to be controls (no treatment) (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit. The results showed that compared with the controls, SpO2 and PaO2 improved for patients in the intervention groups. Paper II was a secondary analysis of data from the RCT including the patients who were assigned to and complied with the mobilization interventions (n = 137). Mobilization initiation time and duration of mobilization were investigated in relation to SpO2 and PaO2. The results indicated that mobilization within the first hour after surgery was not superior to being mobilized within the second hour regarding SpO2 and PaO2. Further, SpO2 and PaO2 were similar between the groups irrespective of whether the patients were mobilized for less than 30 minutes, between 30 and 90 minutes, or longer than 90 minutes. Paper III included face-to-face interviews with 23 patients who were randomized to one of the mobilization interventions. The overarching theme that emerged from the content analysis was “To do whatever it takes to get home earlier”, which was built on the three categories; “The impact of mobilization”, “To feel safe and be confident with the mobilization process”, and “Experiences and motivational factors”. Paper IV, was an interview study of 17 healthcare professionals who had been involved in mobilization of patients in the RCT. The interviews were analyzed with content analysis and resulted in the overarching theme “A changed mindset” which represented a turning point when the healthcare professionals observed that mobilization was safe and beneficial for the patients, and their safety concerns were reduced. The overall conclusion of this thesis was that mobilization immediately after abdominal surgery improved SpO2 and PaO2. Initiation time and duration of mobilization seemed to be of less importance. Patients found that it improved their physical and mental well-being. The healthcare professionals ‘experienced the postoperative recovery unit was a safe place for initiating mobilization as long as they had access to sufficient resources and a wellfunctioning multiprofessional team of nurses, assistant nurses and physiotherapists

First mobilisation after abdominal and cardiothoracic surgery : when is it actually performed? a national, multicentre, cross-sectional study

Objectives: Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively. Design: A prospective observational national multicentre study. Setting: 18 different hospitals in Sweden. Participants: 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia>2 hours. Primary and secondary outcomes: Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs. Results: Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia <4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1-2, (OR: 1.63, 95% CI: 1.13 to 2.36). Conclusions: In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation. Trial registration number: FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634)

First mobilisation after abdominal and cardiothoracic surgery: when is it actually performed? A national, multicentre, cross-sectional study

Objectives Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively.Design A prospective observational national multicentre study.Setting 18 different hospitals in Sweden.Participants 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia>2 hours.Primary and secondary outcomes Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs.Results Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia <4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1–2, (OR: 1.63, 95% CI: 1.13 to 2.36).Conclusions In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation.Trial registration number FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634)